hepatitis b - the conference exchange · 2012-10-19 · hepatitis b in a community health center...
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Leveraging Electronic Health Records and Specific Demographic Data to Screen for
Hepatitis B in a Community Health Center
Leveraging Electronic Health Records and Specific Demographic Data to Screen for Hepatitis B in a Community Health Center
Eve Waltermaurer, PhD
Gena Wilson, MD
Presenter Disclosures
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
Eve Waltermaurer, PhD
No relationships to disclose
• 17 full-time Federally Qualified Health Centers (FQHC) in NYC and upstate NY
• 2 School based health programs
• 4 Dental centers
• 2 Mental health centers
• 2 Free clinics
• 8 Homeless healthcare sites
• 2 Family Medicine Residency Programs
• >300,000 patient visits
• 90,000 unique patients
• 14% uninsured, 44% publicly insured
The Institute for Family Health
• Approximately 800,000 – 1.4 million infected in US
• Vaccine preventable
• 2008: approximately 38,000 new infections
• 90% of those infected perinatally develop chronic Hepatitis B
• 1 in 4 of perinatally infected people will die of complications from Hep B
• Most who are infected perinatally are from Hep B endemic countries
Hepatitis B
DHHS Action Plan on Hepatitis 2011: Statement of Problem:
Leveraging Electronic Health Records and Specific Demographic Data to Screen for
Hepatitis B in a Community Health Center
But…
Race, Ethnicity, and Language Data: Standardization for Health Care Quality ImprovementInstitute of Medicine (IOM); August 2009
“A lack of standardization of categories
for race, ethnicity, and language data has
been suggested as one obstacle to
achieving more widespread collection and
utilization of these data. Many types of
entities participate in initiatives to improve
the quality of health care; health plans,
hospitals, other providers, and health
systems can and should obtain race,
ethnicity, and language data so these
data can be used to identify gaps and
improve care for all individuals..”
Institute of Medicine’s Recommended Variables for Race, Ethnicity and Primary Language (2009)
Source: IOM Report: Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement t
Leveraging Electronic Health Records and Specific Demographic Data to Screen for
Hepatitis B in a Community Health Center
Results after 5 Months:Response to alert by use of attached order set
• 32,515 Fires Occurred
• 3,962 were acknowledged
• 785 had test ordered directly from alert
• 10 previously unknown cases of Hepatitis B identified (1.3%) based on chart review
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
7 mos prior to BPA
(n=1660)
7 mos with BPA
(n=3360)
Proportion not from
Endemic Country
Proportion from
Endemic County
Results after 7 months Testing: BPA Resulted in an 146%
increase in testing of Patients from Endemic Countries
12, 317
28, 1610
0
200
400
600
800
1000
1200
1400
1600
1800
2000
0 5 10 15 20 25 30 35
While a larger proportion of Hepb+ patients were
identified prior to BPA, the wider BPA net resulted in
the identification of 133% more cases.
Total n
screened
with
known
resultsTotal
positives
Results after 7 months Testing: Positive HepB patients among those from
endemic Countries, before (red) and after (blue) BPA implementation
Results after 7 months Testing: Chart records reviewed to confirm new diagnoses
0
2
4
6
8
10
12
14
16
18
7 months before BPA 7 months after BPA
New +HBsAg Among Patients from Hep B
Endemic Countries
New +HBsAg
0.00
2.502.30
0.50
1.20
0.00
1.00
1.30
0.40
0.90
0.00
3.20
5.10
1.10 1.10
0.00
1.00
2.00
3.00
4.00
5.00
6.00
Alaskan,
American Indian,
Hawaiian (N=20)
Asian, Pacific
Islander (N= 282)
Black, African
American
(N=1512)
White (N=1145) Other, Multiple
(N=2453)
Results after One Year of Testing:
Proportion of Positive Hep B by Race
Total
Non-Endemic
Endemic
Note: Missing Race Excluded
County of Origin
Leveraging Electronic Health Records and Specific Demographic Data to Screen for
Hepatitis B in a Community Health Center
HepB + HepB-
From Endemic Country
49 (1.8%) 2676
Not from Endemic Country
30 (0.9%) 3230
Risk Ratio = 1.95 (1.24-3.07)
There is a 2-time increased likelihood of HepB
among those from endemic countries compared
with those who are not
One Year Relative risk of HepB among patients seen after
BPA initiation New Hep B BPA includes other immigrant screening tests
Future Directions:• Initiatives to bring hepatitis
training to IFH residency programs
• Continue provider education efforts on hepatitis
• Positive Hep B smartset to help manage chronic Hep B patients
Institute for Family Health 21
Online Tools for Providers:
• http://www.soapnote.org/infectious/hepatitis-b-chronic/
• http://www.cdc.gov/hepatitis/Resources/Professionals/training/Serology/training.htm
• http://www.aafp.org/online/en/home/publications/news/news-now/health-of-the-public/20120201immunrecs.html
Gena Wilson, MD, ECRIP [email protected]
Joseph Lurio, MD, Chief Medical Informatics Officer
Eve Waltermaurer, PhD Research Consultant, State University of New York, New Paltz
Contact Info: